Pulse wave velocity and its gender-related associations with cardiovascular risk factors in a high cardiovascular risk population.

INTRODUCTION: Associations found between pulse wave velocity (PWV) and cardiovascular risk factors (CVrF) are diverse. We aimed to evaluate whether differences in PWV and its associations with CVrF in a high cardiovascular risk population exist between genders and between the whole population (WHgr) and groups of apparently healthy (AHgr) and those of hypertensive, obese or diabetics (Rgr). MATERIAL AND METHODS: Pulse wave velocity measured by Arteriograph was investigated in 805 adults aged 20-65, randomly selected from the Tallinn Population Register. RESULTS: Pulse wave velocity was the highest in Rgr and no differences were found between genders of the same group. In women of WHgr and AHgr age and SBP with addition of BMI and apolipoprotein B (ApoB) were associated with 54% and 48%, and without ApoB in Rgr with only 30% of PWV values. In men aged ≥ 50 of WHgr with elevated SBP odds ratios for increased PWV were 25.3 and 3.5, in Rgr 21.2 and 2.2, in those aged ≥ 50 AHgr 28.4. In women aged ≥ 50 of WHgr with elevated SBP and diabetes odds ratios were 5.5, 4.9 and 4.0, in Rgr with elevated SBP and diabetes 3.6 and 3.7, in those aged ≥ 50 AHgr 29.3. CONCLUSIONS: The associations of ApoB and BMI with PWV and diabetes with elevated PWV indicative of increased aortic stiffness were unique for women. Aging and SBP were related to PWV even in AHgr, although age ≥ 50 years in Rgr women and normal SBP in AHgr were not associated with elevated PWV.

Prevalence of cardiovascular disease risk factors in Tallinn, Estonia.

BACKGROUND AND OBJECTIVE: Cardiovascular diseases are still a major public health concern in Estonia despite the decline in the mortality rate during the past decade. For better preventive strategies we aimed to investigate the prevalence of cardiovascular disease risk factors and their relations with age, gender and ethnicity. MATERIALS AND METHODS: The cross-sectional study was carried out in Tallinn, Estonia. Two hundred individuals from each of the sex and 10-year age group (range 20-65 years of age) were randomly selected and invited to participate. Final study sample consisted of 511 men and 600 women (mean age of 46 years). Physiological measurements were taken and blood samples were drawn for standard measurements of the following markers: total cholesterol, high- and low-density lipoprotein cholesterol, apolipoproteins, triglycerides, glucose and inflammatory markers. RESULTS: Overall, 31% of the study subjects had high blood pressure, 23% had metabolic syndrome, and 55% were overweight/obese. The prevalence of all risk factors increased with age amongst both genders. The proportion of individuals having increased cholesterol, apolipoprotein B-100, and homocysteine levels was very high amongst both genders (60-80%). More Russians and other ethnic minorities compared to ethnic Estonians had calculated 10-year CHD risk≥10%. CONCLUSIONS: The study established a high prevalence of cardiovascular disease risk factors in Estonian adults (20-65 years of age). Younger portion of the population and some extent ethnic considerations should be taken into account when designing future studies, health prevention activities and interventions.

Prevalence and determinants of hypertension in Estonian adults.

BACKGROUND: Although Eastern Europe, including Estonia, has one of the highest morbidity and mortality rates associated with hypertension, there is little information in the literature concerning the biochemical risk factor profile or its association with hypertension in Estonia. This study examined the cross-sectional gender-stratified association between biochemical risk markers and hypertension in a population-based sample of adults in Estonia. METHODS: The study was carried out in Tallinn, Estonia and consisted of 511 men and 600 women with a mean age of 46 years. Physiological measurements were taken and blood samples drawn to measure the following markers: cholesterol, high- and low-density lipoprotein cholesterol, apolipoproteins A-1 and B, lipoprotein(a), triglycerides, glucose, fibrinogen, high-sensitivity C-reactive protein and homocysteine. RESULTS: Overall, 36% of participants had hypertension, with approximately 80% being aware of their condition. A total of 40% of participants reported taking antihypertensive medication. Multivariate binary logistic regression analysis showed that a decrease in high-density lipoprotein cholesterol and increases in age, body mass index, apolipoprotein B, triglyceride and homocysteine levels were associated with an increased probability of hypertension. CONCLUSIONS: Elevations in biochemical markers and cardiovascular risk factors are associated with hypertension. Increasing body mass index, triglyceride, apolipoprotein B and homocysteine levels with decreasing high-density lipoprotein cholesterol level should be investigated and monitored in Estonian adults.

Cholesterol-rich low density lipoproteins are also more oxidized.

Cardiovascular diseases are accompanied by active oxygen species and organic free radical generation. The aim of this study was to examine the possibility of using oxidized low-density lipoprotein (oxLDL) as a new diagnostic biomarker. Epidemiological study in populations of Estonia (782 subjects) and Russia (1433 subjects) was carried out in 2007-2009. The screening procedure included standard epidemiological methods. Oxidative stress was assessed by measuring the level of oxLDL using immunoassay method. Positive correlation between the levels of oxLDL and LDL cholesterol was indicated in blood of patients from estonian (r = 0.61; P < 0.05) and russian (r = 0.56; P < 0.05) populations. In russian population oxLDL/HDL cholesterol ratio was higher in the groups with highest risk of atherosclerosis development or manifest coronary artery disease (CAD). Cholesterol-rich low density lipoproteins are also more oxidized. Estimation of oxLDL/HDL ratio may be used as an independent biochemical marker for atherosclerosis.

Malondialdehyde-modified low-density lipoproteins as biomarker for atherosclerosis.

BACKGROUND: Cardiovascular diseases are accompanied by the presence of active oxygen species and organic free radical generation. The aim of this study was to examine the possibility of using malondialdehyde (MDA)-modified low-density lipoprotein (LDL) analyses as a diagnostic and prognostic biomarker. DESIGN AND METHODS: A cross-sectional epidemiological study of a random sample of the male population of Tallinn aged 20-64 was carried out in 2007-2008. A total of 413 subjects were included in the study. The screening procedure included standard epidemiological methods. Oxidative stress was assessed by measuring the kinetics of glutathione oxidation and the level of oxidized of MDA-modified LDL. RESULTS: A strong positive correlation between levels of MDA-modified LDL- and total cholesterol was indicated, as well as LDL-cholesterol in blood of patients with postinfarct cardiosclerosis (r=0.82 and r=0.83, respectively, p<0.05). Hypercholesterolemia and hyperglyceridemia were accompanied by significant increase in oxidized LDL plasma level. CONCLUSION: MDA-modified LDL estimation has a diagnostic accuracy and may be used as an independent biochemical marker for atherosclerosis.

Blood pressure and contributing factors in inhabitants of Estonia: 15-year trends.

AIM: To study the 15-year trends of blood pressure (BP) values in inhabitants of Estonia, three independent random samples of the population of Tallinn aged 20-54 years were examined in 1984/86, 1992/94 and in 1999/2001. RESULTS: A substantial decrease in BP values was observed in the population of Tallinn by the early 1990s; it continued to a smaller extent during the late 1990s. An improvement in some factors contributing to the development of arterial hypertension: decrease in body mass index (BMI) mean values and positive dietary changes were observed during this period. In the late 1990s, the changes in contributing factors were less synonymous. In men, the BMI mean values, intake of calories and alcohol increased but smoking rates dropped substantially; physical activity and P/S ratio increased. In women, the BMI mean values, which decreased considerably between the 1980s and early 1990s, remained stable, as well as smoking rates; physical activity increased and positive changes in nutrition were more pronounced than in men. The BP values also decreased in women to a greater extent than in men. CONCLUSION: Favourable trends in BP and contributing factors were found in Estonia during the transition period accompanied by a cardiovascular disease mortality decline since 1995.

QT dispersion in relation to left ventricular geometry and hypertension in a population study.

OBJECTIVE: To study the relationship between QT interval dispersion, arterial hypertension and different left ventricular geometric patterns in the framework of a population study. DESIGN: A random sample of the population of Tallinn, 717 men and women aged 35-59, underwent standard 12-lead ECG at rest and echocardiography. Corrected QT dispersion was considered as prolonged when the duration was > or =70 ms. RESULTS: In hypertensives with concentric and eccentric hypertrophy, the mean values of corrected QT dispersion were significantly higher than in those with normal geometry. In the normotensive group no significant differences of the mean values of corrected QT dispersion were found in relation to left ventricular geometry. Mean values of corrected QT dispersion were higher in hypertensives than in normotensives in each left ventricular geometric pattern. Corrected QT dispersion > or =70 ms was mainly associated with concentric hypertrophy. CONCLUSION: Prolonged corrected QT dispersion is associated with left ventricular geometric abnormalities and arterial hypertension and is mostly related to concentric hypertrophy.

Arterial hypertension, left ventricular geometry and QT dispersion in a middle-aged Estonian female population.

The aim of the present study was to determine the prevalence of Left ventricular hypertrophy (LVH) and different left ventricular (LV) geometric patterns in the middle-aged women population of Tallinn, to assess the relationship between LV geometry, age, blood pressure and LV repolarization duration and inhomogeneity. A random sample of the population, 482 women aged 35-59, was examined in the framework of a cardiovascular risk factors survey for the WHO/CINDI programme years 1999-2000. Patients with valvular pathology, primary cardiomyopathy, atrial fibrillation, bundle branch blocks and flat T wave on electrocardiography (ECG) were excluded; 398 (82.2%) of the participants underwent echocardiography (Echo) and standard 12-lead ECG at rest and were included in the study. LVH was defined if left ventricular mass (LVM), LVM/height and LVM/BSA were >198 g, >121 g/m and > 120 g/m2, respectively. Arterial hypertension was determined in 23.1% of the women. The prevalence of arterial hypertension was three times higher in those aged 50-59 than in those aged 40-49 (37.4% vs 13.2%; p < 0.05). Different geometric patterns were found as follows: concentric hypertrophy in 9.1%; eccentric hypertrophy 33.9%; concentric remodelling 9.5% and normal geometry 47.5% of the participants. Concentric hypertrophy was found exclusively in hypertensive women and increased with age. No age-related eccentric hypertrophy and concentric remodelling differences were found, either in the normotensive or in the hypertensive group. Prolonged QT dispersion--a marker of increased myocardial electrical instability, was associated with LVH and arterial hypertension and was related mostly to concentric hypertrophy in hypertensives.

Echocardiographic assessment of the different left ventricular geometric patterns in middle-aged men and women in Tallinn.

The aim of this study was to determine the association of left ventricular (LV) geometry with sex, age, arterial hypertension and obesity in Tallinn. In a framework of a population study for cardiovascular risk factors, echocardiography was carried out in 325 men and 398 women (69.3% of all 1043 participants aged 35-59) in 1999-2001. Left ventricular hypertrophy was defined if left ventricular mass (LVM), LVM/height and LVM/body surface area were 294 g, 163 g/m and 150 g/m2 in men, and 198 g, 121 g/m and 120 g/m2 in women, respectively. LV geometry was analysed according to four types generally recognized (with regard to relative wall thickness > 0.45). The prevalence of concentric hypertrophy was similar in men and women: 7.7% and 9.1%. The prevalence of eccentric hypertrophy was significantly higher in women than in men (33.3% vs 4.9%). Concentric remodelling was also found in women more often than in men (9.5 vs 5.5%; p < 0.05). Regardless of sex and age, concentric hypertrophy was never found in participants with blood pressure < 140/90. In hypertensives, there was a tendency for age-related increase of concentric hypertrophy prevalence: the latter was higher in women than in men: 39.1% vs 25.5%; p < 0.05. In examinees with BMI < 30, this type of LV geometry was seldom found: in 3.1% of men and 5.0% of women; p < 0.05. In obese persons, it increased with age, reaching 26.5% in men and 21.2% in women (p < 0.05). The prevalence of eccentric hypertrophy in men increased with age, and with hypertension and obesity. The prevalence of concentric remodelling in men was not related to BMI; it was significantly more often found in older age groups and in hypertensives. In women, the prevalence of eccentric hypertrophy and concentric remodelling was not related to age, hypertension or obesity.

Some biological cardiovascular risk factors and diet in samples of the male population of Tallinn, Estonia in 1984/1985 and 1992/1993.

BACKGROUND: The role of diet in the development of atherosclerosis and coronary heart disease is well known from animal, clinical and epidemiological studies; the influence of dietary factors is realized through their impact on body mass, lipids and blood pressure. The aim of this investigation was to study the levels of some biological risk factors: blood pressure, total cholesterol, triglycerides and body mass, as well as nutrition, in the male population of Tallinn, the capital of Estonia, in 1984/1985 and 1992/1993 (the transition period). METHODS: Two independent random samples of the male population of Tallinn, aged 30 to 54, were examined in 1984/1985 (1,890 men) and in 1992/1993 (752 men). Standard epidemiological investigation methods were used; the diet was studied by the 24 h recall method. RESULTS: By the time of the second survey the age-adjusted mean values of systolic and diastolic blood pressure, body mass index and triglycerides, as well as the prevalence of arterial hypertension, hypercholesterolaemia and hypertriglyceridaemia were lower than at the first survey. These data were in accordance with the dietary pattern: lower energy, animal protein, fat, saturated fatty acids, cholesterol intake and higher consumption of vegetable protein and P/S ratio at the second survey. Taking into account close relationships between many nutrients and biological risk factors found previously, changes in the diet of the population, which occurred in postsocialist Estonia in the early 1990s, could be regarded as one of the reasons for the differences in the levels of these risk factors.